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APPLICATIC�� 1 FOR CON�TRUCT'�'1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> ; _ _ _ _ _. - --� <br /> H[ATING SYSTEM�. J GAS J ELECTRIC J___ _ __ _ � <br /> BUILDING DFPARTMENT � - --___ <br /> 259 8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL �PLUMBING SIGN <br /> - -- -_ _-- - _ - <br /> � cn,rN e�nin�i n��., �rtv T'- ---- <br /> Tu�� T(7 v��oNl <br /> �' f72/G 5 /�/U/42 £7 / 8 3 / �_-1 r/2 /.:7v c f_=�, r� /7' {'- r' _ �c• 5 7 <br /> '11l�Ni IA411.AppqES$ ;iiV Jil� PN NE ` <br /> ���iCwiECTOPOF.SiGNE9 M�II�DURE55 (ITY 21P PNONE <br /> ���NFR�ICONTNICTOR 6UI1.A0[1RE55 f.TV Ili PHON! SUTEIICENSE• <br /> i'fP�.W1ULGONTq�CTOR MRiL�00RE55 C��y IiP P�iONF. S1�TELILENSE� <br /> �'i�.iRip'NGf,ONiRACipq Abnl ADORESS CITI zl� f� A PHONE�0 � SiRTE LICENSF/ <br /> �1�/_�-S /��`�i» 4�A_ �S�_/9Fa4 S�u (. Yl�It� [1�00 Cc,� 7V,• 37C� 3 /AT- <br /> � �,aranclraicrorwor�� � _� � I�AI�1_Sl�/21$� <br /> '�f9Cql3(WOPNr1NOSOUPP[fOpTACE1NVIXVED � (',trN�Ar., Pf�50NRNOPHONENO <br /> !��_a% /)IP C f. . —._ _ __"___—"_ ___— — <br /> -- i HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> �����,�;�o�senu F �_niNr, qppLICAT10N AND KNOW iHE SAME TU BE TRUE AND CORRECi. ALL <br /> PROVISIONS OF LAWS AND OFlDINANCES GOVERNING THIS TVPE OF <br /> �cni.pescRmr�Eq,r�sNowrine�owoAert�cNtwocori[si WORK WILL BE COMPLETED WITH WHE7HER SPEGFIED HF9EIN OP <br /> ,,,� yi�K oF _ NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �UTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> __ OTHER STATE OR LOCAL LAW flFGULATING CONSTRUCTION OR THE <br /> ----� PERFOFh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV "f0 °ERFORM THE WORK FOR WHICH <br /> - -- ----- -- ---- APPUCATION IS MADE AND I COMPLV WI?H TH[ STATE <br /> r�nncep�uz i o Nu�.�nen <br /> _Sb�pZ - �JS � '�C7� '" O �O � CONiRACTORSLAW10.2iRCWAND296.200WAC <br /> i n��9tquCtlON I OAN IFN�f-R 4�ORE55 ICLCPHONF NUMP�❑ /��'�l <br /> __ '_— X / /-� ��I <br /> PROJE T ADORESS __ _.___ ._.-___. ._. ._ . /�� .�,-. .r _�J� _________ <br /> 2/ � <br /> � <br /> _ � /; i <br /> -- - <br /> I �, �,u�,�,. - — --- �r.�� <br /> r; <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOS[T�TOILETI A�C-A HNDLG UNITS-H.P. <br /> � BATHTUB FORCEONRSVSTEMS-B.T.LL M EA. �— <br /> � LAVATONV�WASH BASIN) UNIT HEATERS-B.T.U. M 1— <br /> �( SHOWER CLOTHES�RVERS <br /> _ T KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHcR �-- <br /> _ . .I__ ____ RANGE HOOD <br /> LAUNDRV �RAV WATER HEATER <br /> .�I CLOTHE�WASHER _ WOOD STOVE <br /> .. URINAL METAL FIREPLACE(WOUD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> � � <br /> FLOOH DRAIN HEAT PUMP <br /> ____ BACKFLOW PREVENTERS GAS PIPING <br /> _ ROOF DRAINS-RAINLEADERS EXHAUST FAN �- <br /> SINH�SENVICE-BAF.ETG) — <br /> —__ --- __ �(t_ /�-fN��lt'll. -._ . <br /> -_.. _ — — __ -r-__ <br /> _ _ _ _ _ SUB TOTAL $ SUB TOTAL $ <br /> _ __ ___._____. PERMIT q �J -- PERMIT 5 ..._ <br /> —. — _._—_. _ --. - ... ._.___ __ .. _—_.._.-- ' _ <br /> TOTAL FEE 3 �h iOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> iHONiSFIPACK n1�Rti[iqnCK SIDESETORCN ���qNGi C lIUM119�f� r[! RtcFin�NO <br /> _------ --- <br /> �G i�l <br /> ���.riuN[ �ourarn wcnqrsire PEES VALUATION FEE <br /> �� VES - NO puao�Nc r— <br /> �,:�r o�caHst mo aFsronies «�q�,�;�,. xo Mm�n��n�,�,,.----- . _. _ . - -- -- -_ . �_ . <br /> ri.uMowr, ------- . .. C ' - <br /> ' .'� ��19LOG FIRESPRiNNLERSPCOD BRSEVF.S ��. NO MF.CHANICAL _ — �� <br /> '�i�•nNcvlo�0 FwEAURMnEOD ��eic�rt;.nuTqnaa ADDITIONALPIANCHECK <br /> —__ OTHfR � <br /> ��.� �ni ___'_. — ___-- _—_ —__'_�—.' <br /> STA7�f1111DING SURCHARGF ' <br /> _._. _ _--' '__— —__ _—'—._'__ <br /> ^�i^�txr r�unsnrrnnvtnnv CITYOFEVERETT rueucwonks <br /> LOCAL SALES <br /> ���� TAX CODE IS 3105 TGTAL <br />